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Five-year-old Joy Azu’s mother was terrified when she noticed that her daughter was bleeding through the nose. She placed a pillow behind her head, slightly bending it backward. It worked as the flow slowly stopped but it took two years for little Azu to be free of the condition as it continued to re-occur because the pillow solution was ineffective.
Describing his fear when he noticed the flow of blood through his nose at seven, Iniobong Effiong, who is now a teenager, said the period was challenging and emotionally tasking for his parents.
His nosebleed lasted for more than a year and his mother had no idea of how to handle his condition.
“Because I was young, I had no idea of what was happening to me. I tried to blow it out but it got worse and my mother had little knowledge of its treatment. She later learnt that the safe position when it occurs is to push the head backward, using a soft object like a pillow to support the neck. It stopped after a year,” he said.
Apart from children, adults too experience nose bleeding. At 37, Segun Olanrewaju still suffers bleeding through the nose.
He said, “I experienced it twice some months back. It started suddenly. I had gone out to work somewhere in Lagos without any strange feeling. But when I got back to my office, my nose started bleeding. The bleeding was so much. My shirt was stained with blood. My colleagues had to rush me to the hospital. My doctor said the bleeding was triggered by stress, I never knew that stress causes nosebleed.”
Olarenwaju, who said he was distressed with the condition, advised mothers not to allow their children place their heads on pillows. “I was advised by my doctor not to place my head on pillows as this would cause a backward flow of blood into the brain,”he said.
While she was pregnant, Mrs. Stella Nwosu, also had nosebleed. Like many others, she had no idea how to stop it.
She said, “During my pregnancy months, I didn’t have discomforts such as vomiting, spitting or weakness. In fact, I was very strong, but the only thing I battled with was nosebleed. On several occasions, my nose would be bleeding profusely. It got to a point that I became so worried because I didn’t want anything to happen to my unborn child. When I complained to my doctor, he said there was nothing to worry about and that the condition was just part of pregnancy symptoms. I’m glad the condition didn’t get worse. It can be frightening; imagine seeing blood coming out of your nose. Anyone would be scared.”
These are just a few cases of both children and adults who have battled with nosebleed. But what exactly is nosebleed and what are its causes?
According to Medical News Today’s website, the medical term for nosebleed is epistaxis otherwise called nasal hemorrhage.
The website stated, “The human nose and those of many animals are rich in blood vessels. Because of the position of the nose – right in the middle of the face – and all its blood vessels, most of us will have had at least one nosebleed at some time during our lives.
Nosebleeds are seldom a cause for alarm but can be life threatening in rare cases. Spontaneous nosebleeds are fairly common, especially in children. When the mucous membrane (a mucus-secreting tissue) inside the nose dries, crusts, or cracks (the skin splits open) and is then picked, it is likely to bleed. Because the nose is full of blood vessels and is inconveniently situated in the middle of the face, any minor injury to the face can cause the nose to bleed profusely.
“Nosebleeds are also common in people taking anti-coagulants (blood-thinning medications, such as Aspirin), as well as in older people whose blood may take longer to clot. If the patient is taking anti-coagulants, has hypertension (high blood pressure), or a blood-clotting disorder, the bleeding may be harder to stop and could last over 20 minutes.”
Another website, Firstaid.webmd, explained that nosebleed is divided into two types, depending on whether the bleeding is coming from the anterior (front of the nose) or posterior (back of the nose).
It sates, “Anterior nosebleeds make up more than 90 per cent of all nosebleeds. The bleeding usually comes from a blood vessel at the very front part of the nose. Anterior nosebleeds are usually easy to control, either by measures that can be performed at home or by a doctor. Posterior nosebleeds are much less common than anterior nosebleeds. They tend to occur more often in elderly people. The bleeding usually comes from an artery in the back part of the nose. These nosebleeds are more complicated and usually require admission to the hospital and management by an otolaryngologist (an ear, nose, and throat specialist).
“In the US, one of every seven people will develop a nosebleed at some time. Nosebleeds tend to occur during winter months and in dry, cold climates. They can occur at any age but are most common in children aged two to 10 years and adults aged 50 to 80 years.”
A medical doctor, Dr. Shabi Abidemi, added that adults who suffer from nosebleed may have hypertension.
Speaking with our correspondent, he said, “Nosebleed in children could be as a result of trauma or tumour, but in adults, the likely cause is hypertension, especially when there is no injury in the nose. Nosebleed also occurs in people that have bleeding disorder, which is called haemophilia. This means when the blood doesn’t clot because of a deficiency.”
In children, Abidemi said nosebleed could be as a result of systemic illness, infection, tumour or metabolic disease. However, for children, he said the commonest cause is trauma.
“Children who pick their nose especially when the weather is dry may develop nosebleed. This is because the nose isn’t properly moisturised. When it starts bleeding, the commonest home remedy is for the mother to pinch the anterior part of the nose. This will apply pressure on the nose. Then, the child should be made to lean forward and not backwards. The mother could also apply an icepack on the bridge of the nose. These are just home remedies, if the bleeding persists, the child should be taken to the hospital immediately,” he said.
From a haematologist’s perspective, Dr. Tosin Adeyemo, said a child or adult that suffers from nosebleed would require some tests to unravel the possible cause. “The cause of this condition can range from a vascular disorder or platelet disorder. However, this kind of problem requires a multidisciplinary approach with an ear, nose and throat surgeon, including a neurosurgeon. Once these specialists have performed their skilled tests on the individual, and they deem the person as being ok, then a haematologist can assist with further tests,” she said.
Adeyemo further said nosebleed can affect any age group and that it isn’t limited to children.
“Causes include excessive nose picking especially during a harsh and dry season, which will further aggravate the condition. But for more serious problems, like a vascular and or platelet disorder, the bleeding might be more intense or prolonged. The nosebleed can last for as long as the trigger persists.
“It can be treated based on what the primary problem is. For example, a nose picker should be discouraged from the act. For deeper problems such as the platelet disorder, the individual will benefit from replacement therapy. Once an individual has nosebleed, he or she should seek immediate medical attention so as not to aggravate the condition,”she said.
Idiopathic- no known cause
1. Osler - Rendu - Weber Syndrome (Congenital Teleangectasis-localised collection of distended blood vessels)
2. Haemophilia- a disorder in blood clotting
Trauma – nose picking, foreign body in nose, sports, assault, road traffic accidents, instrumentation from surgeries etc
1. Acute Inflammatory conditions-Infective Rhinosinusitis
2. Chronic Inflammatory conditions-Atrophic rhinitis, Tuberculosis (Nasal TB), Syphilis etc
Chemical lesions - Inhalation of irritant chemicals, gases etc
Neoplasm of the Nose / Sinuses
1. Benign tumours - eg, Nasal polyps
2. Malignant tumours of nasal cavity or sinuses
- Enviromental / climatic changes - Dry hazy and low relative humid weather conditions.
Generalized conditions- Diseases with vascular changes (Ateriosclerosis, Hypertention)
Diseases of the Blood- Leukemia, thrombocytopenia (low platelets)
Prodromal stage of certain Infectious diseases - Diphtheria, Measles, Varicella,Chicken pox
Conditions of Organ failure –hepatic, renal failures
Physiological conditions- Vicarious menstruation (menstrual bleeding from a part of the body other than the vagina-nose, nipple, mouth etc)
- 1. Pinching of the nose for about 2-3 minutes whiles using the mouth for breathing is the single most important first step to take.
2. Nasal packing - this is a process of packing the nasal cavity tightly with a sterile gauze applying the pressure technique to stop bleeding.
3. If bleeding doesn’t stop after this rush immediately to a nearby hospital.
4. Do not try to drain the blood into your mouth- the bleeding will not stop and you may aspirate the blood into your lungs.
5. Cauterization (using heat or chemicals to destroy tissues by direct application of heat or chemicals) –in this case to prevent bleeding.
6. Arterial Ligation- suturing of the bleeding vessels.
- 1. Avoid nose picking- it is the most common cause of nose bleeding (from injury to the complex network of blood vessels in the little’s area or Kiesselbach’s plxus).
2. Take your drugs regularly if you are hypertensive.
3. Protect your face in contact sports.
4. Do not ignore recurrent bleeds. Have a doctor work-up on you for possible causes and management.
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